Program Operations Manual System (POMS)

A. Definitions of adverse actions applicable to initial claims

1. Adverse action

An adverse action is a determination resulting either in, non-entitlement, the termination
of entitlement or in a benefit reduction to an earlier (i.e., a currently entitled
or previously entitled) beneficiary because of a subsequent award to a late-filing
claimant on the same social security number (SSN).

2. Adverse claim

An adverseclaimis an award of benefits (as initial claim) to a subsequent claimant or the reinstatement
or resumption of benefits to a prior beneficiary that results in the non-entitlementor terminationof an earlier beneficiary.

3. Adverse adjustment

We consider a claim as an adverse adjustment when it meets the following criteria.

a.

The family maximum provision results in a reductionin the pastorpresentbenefit payment rates of an earlier entitled beneficiary due to:

The “late filer” is not part of the same household as the adversely affected beneficiary.
Refer to RS 00615.760 for definition of “late filers”.

IMPORTANT: Do not confuse the late filer(s) with a “delayed” claimant. If the original application
does not protect the claimant or files after the closeout period had ended, the claimant
is a “late filer”.

EXAMPLE: Gina Huntley is the number holder (NH)'s daughter by a prior marriage and lives in
a separate household. She filed for student benefits on April 30 on her father's SSN
however, she turned age 18 on January 12 and graduated from high school the following
June. Claimants with Benefit Identification codes (BICs) “A”, “B2”, and “C1” had been
receiving benefits on this SSN since February. Gina receives her first and only payment
as BIC “C2” in July, representing monthly benefits due for April, May and June. Her
student benefit entitlement terminated in July per RS 00205.350D.

We consider Gina’s claim an adverse adjustment because her entitlement caused a reduction
in the benefits of “B2” and “C1” for April, May and June. Therefore, we must send
an advance due process notice of the adverse adjustment to “B2” and “C1” see GN 01010.330.

NOTE: Certified benefit rates for the retroactive period up to, but not including the late
filer's month of filingare protected under Section 202(j)(1) of the Act for unreduced beneficiaries already
entitled on the same SSN (see RS 00615.760 through RS 00615.761). Only the part of the family maximum (FMAX) that the system does not certified for
payment within the retroactive period is due, see RS 00601.020 for rounding of benefits.

B. Definitions that apply to auxiliary and survivor claims

The following definitions apply to auxiliary and survivor claims for the purposes
of applying the rules of adverse actions.

1. New claim

A newclaimis a subsequent award for an auxiliary not previously entitled on the SSN (i.e., a
Master Beneficiary Record (MBR) already exists) in which other claimants are already
receiving benefits.

2. Re-entitlement to benefits

A re-entitlementis a subsequent award for an auxiliary or survivor previously entitled on an SSN whose
prior benefits were correctly terminated (e.g., interruption of full-time student
attendance or a break between an age 18 termination event and the establishment of
a subsequent date of onset for childhood disability benefits). This break in entitlement
must be for at least one month. A new application is required for a re-entitlement.

3. Resumption of benefits

Resumption of benefitsis a continuation of benefits to an auxiliary or survivor erroneously terminated when
evidence received subsequently establishes ongoing entitlement (e.g., continuous student
or childhood disability entitlement is established after an age 18 termination event
has processed). No new application is required for resumption of benefits.